﻿<?xml version="1.0" encoding="utf-8" ?>
<TransactionSpecification xmlns="http://tempuri.org/X12ParserSpecification.xsd" TransactionSetIdentifierCode="271">
  <Segment SegmentId="BHT"/>
  <HierarchicalLoop LoopId="2000A" LevelCode="20">
    <Name>Information Source Level</Name>
    <Segment SegmentId="AAA"/>
    <Loop LoopId="2100A">
      <Name>Information Source Name</Name>
      <StartingSegment SegmentId="NM1"/>
      <Segment SegmentId="PER"/>
      <Segment SegmentId="AAA"/>
    </Loop>
  </HierarchicalLoop>
  <HierarchicalLoop LoopId="2000B" LevelCode="21">
    <Name>Information Receiver Level</Name>
    <Loop LoopId="2100B">
      <Name>Information Receiver Name</Name>
      <StartingSegment SegmentId="NM1"/>
      <Segment SegmentId="REF"/>
      <Segment SegmentId="AAA"/>
      <Segment SegmentId="PRV"/>
    </Loop>
  </HierarchicalLoop>
  <HierarchicalLoop LoopId="2000C" LevelCode="22">
    <Name>Subscriber Level</Name>
    <Segment SegmentId="TRN"/>
    <Loop LoopId="2100C">
      <Name>Subscriber Name</Name>
      <StartingSegment SegmentId="NM1"/>
      <Segment SegmentId="REF"/>
      <Segment SegmentId="N3"/>
      <Segment SegmentId="N4"/>
      <Segment SegmentId="AAA"/>
      <Segment SegmentId="PRV"/>
      <Segment SegmentId="DMG"/>
      <Segment SegmentId="INS"/>
      <Segment SegmentId="HI"/>
      <Segment SegmentId="DTP"/>
      <Segment SegmentId="MPI"/>
      <Loop LoopId="2110C">
        <Name>Subscriber Eligibility or Benefit Information</Name>
        <StartingSegment SegmentId="EB"/>
        <Segment SegmentId="HSD"/>
        <Segment SegmentId="REF"/>
        <Segment SegmentId="DTP"/>
        <Segment SegmentId="AAA"/>
        <Segment SegmentId="MSG"/>
        <Loop LoopId="2115C">
          <Name>Subscriber Eligibility Or Benefit Additional Information</Name>
          <StartingSegment SegmentId="III"/>
        </Loop>
        <Loop LoopId="LS">
          <Name>Loop</Name>
          <StartingSegment SegmentId="LS"/>
          <Segment SegmentId="LE"/>
          <Loop LoopId="2120C">
            <Name>Subscriber Benefit Related Entity Name</Name>
            <StartingSegment SegmentId="NM1"/>
            <Segment SegmentId="N3"/>
            <Segment SegmentId="N4"/>
            <Segment SegmentId="PER"/>
            <Segment SegmentId="PRV"/>
          </Loop>
        </Loop>
      </Loop>
    </Loop>
  </HierarchicalLoop>
  <HierarchicalLoop LoopId="2000D" LevelCode="23">
    <Name>Dependent Level</Name>
    <Segment SegmentId="TRN"/>
    <Loop LoopId="2100D">
      <Name>Dependent Name</Name>
      <StartingSegment SegmentId="NM1"/>
      <Segment SegmentId="REF"/>
      <Segment SegmentId="N3"/>
      <Segment SegmentId="N4"/>
      <Segment SegmentId="AAA"/>
      <Segment SegmentId="PRV"/>
      <Segment SegmentId="DMG"/>
      <Segment SegmentId="INS"/>
      <Segment SegmentId="HI"/>
      <Segment SegmentId="DTP"/>
      <Segment SegmentId="MPI"/>
      <Loop LoopId="2110D">
        <Name>Dependent Eligibility or Benefit Information</Name>
        <StartingSegment SegmentId="EB"/>
        <Segment SegmentId="HSD"/>
        <Segment SegmentId="REF"/>
        <Segment SegmentId="DTP"/>
        <Segment SegmentId="AAA"/>
        <Segment SegmentId="MSG"/>
        <Loop LoopId="2115D">
          <Name>Dependent Eligibility Or Benefit Additional Information</Name>
          <StartingSegment SegmentId="III"/>
        </Loop>
        <Loop LoopId="LS">
          <Name>Loop</Name>
          <StartingSegment SegmentId="LS"/>
          <Segment SegmentId="LE"/>
          <Loop LoopId="2120D">
            <Name>Dependent Benefit Related Entity Name</Name>
            <StartingSegment SegmentId="NM1"/>
            <Segment SegmentId="N3"/>
            <Segment SegmentId="N4"/>
            <Segment SegmentId="PER"/>
            <Segment SegmentId="PRV"/>
          </Loop>
        </Loop>
      </Loop>
    </Loop>
  </HierarchicalLoop>
</TransactionSpecification>
